title: The presence of CD4 counts for the management of HIV patients in East Africa: a multicentred study.
abstract: New WHO guidance stipulates six-monthly CD4 testing and treatment initiation at CD4 less than 350. This study aimed to determine the presence of CD4 results in patient records across five care facilities in Kenya, and to identify factors associated with the presence of CD4 count. This is a cross-sectional study of consecutive outpatients. Participants completed self-reported outcomes of demographics, and both physical and mental health dimensions of quality of life and function; charts were reviewed for a CD4 count in the previous 13 months; 548 patients participated. For those diagnosed during the 13-month study period, 7.1% of the sample had no CD4 result on record. For those diagnosed prior to the study, 8.7% had no result. Multivariate logistic regression revealed that 30 days post-HIV diagnosis, facility and antiretroviral therapy use were associated with the odds of having a CD4 result on file. At six months, poverty and prevalence of multidimensional problems were associated with lack of CD4 result. For those diagnosed prior to the observation period, education level was associated with more infrequent CD4 counts, and facility and number of dependants were associated with odds of a CD4 result within six months. Our data suggest inconsistencies in CD4 results availability within and between facilities. Implementation of new guidance will require a shift in practice.
authors.affiliation: a Department of Palliative Care, Policy & Rehabilitation, King's College London , Cicely Saunders Institute , London , UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
authors.forename: Victoria
authors.initials: V
authors.lastname: Simms
authors.forename: Suzanne
authors.initials: S
authors.lastname: Penfold
authors.forename: Julia
authors.initials: J
authors.lastname: Downing
authors.forename: Richard A
authors.initials: RA
authors.lastname: Powell
authors.forename: Faith
authors.initials: F
authors.lastname: Mwangi-Powell
authors.forename: Eve
authors.initials: E
authors.lastname: Namisango
authors.forename: Scott
authors.initials: S
authors.lastname: Moreland
authors.forename: Nancy
authors.initials: N
authors.lastname: Gikaara
authors.forename: Mackuline
authors.initials: M
authors.lastname: Atieno
authors.forename: Jeniffer
authors.initials: J
authors.lastname: Kataike
authors.forename: Clare
authors.initials: C
authors.lastname: Nsubuga
authors.forename: Grace
authors.initials: G
authors.lastname: Munene
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Banga
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D017408:Guidelines as Topic; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D057566:Self Report; D011795:Surveys and Questionnaires; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents